Two articles at extreme ends of the spectrum appeared last week.
First we had this:
Why one practice ditched EHR in favor of paper records
Aug 14, 2017 11:52am
The Illinois Pain Institute has done what many physicians only dream about doing. The practice, which has multiple locations in four Illinois counties, just ditched its electronic health record (EHR) and went back to paper records.
The private practice voted unanimously to take the step back to paper records two years ago and has not regretted it, John Prunskis, M.D., founder and co-director, told Becker’s Hospital Review.
"We felt the level of patient care was not enhanced by an electronic health record. We saw it was inefficient and added nonproductive work to physicians' time,” Prunskis told the publication.
Almost all physicians in the United States have transitioned to EHRs, according to a 2016 report. Doctors' biggest gripe is the erosion of the physician/patient relationship as they spend too much time looking at a computer screen and not enough time looking at patients.
A Mayo Clinic study last year found use of EHRs reduces physician satisfaction and contributes to higher rates of burnout.
The full article is here:
Then a few days later we had this:
Doctors loathe their EHRs, right? Not these physicians
Amid the uproar about how hard electronic health records can be to use, a small contingency of doctors are saying the software has made them much better caregivers.
August 18, 2017 11:50 AM
EHR dissatisfaction is rampant. Doctors complain about too many clicks and unusable interfaces, to name just two common gripes. Health IT pros and clinicians hear and read about these problems a lot. But the other side of the story -- physicians who say the EHR makes them better doctors -- is less-often told.
“Yes, I love the EHR I use,” said James Legan, MD.
Legan, an internal medicine physician in Great Falls, Montana, who credits the EHR for helping him to practice medicine more effectively, is not alone. Medical Group Management Association CEO Halee Fischer-Wright, MD, while perhaps less exuberant than Legan, said EHRs have considerable promise in the practice of medicine. And then there’s Jeffrey Cleveland, MD, a pediatrician at Carolinas HealthCare System.
Cleveland even went so far as to say that implementing Cerner had an immediate and positive impact on his ability to care for patients.
“I was a better doctor overnight,” Cleveland said. “Absolutely. There’s no question in my mind. I was a better doctor in March 2008 than I was in February of 2008 – because I instantly had data.”
How EHR love came to Carolinas
When Cleveland started practicing medicine in 1994 at Charlotte Pediatrics Clinic in Matthews, North Carolina, there was no EHR system, and there wouldn’t be one for another 14 years.
The clinic is part of the sprawling Carolinas HealthCare System, which today operates 900 care locations in North Carolina and South Carolina.
The work of getting the health system’s Cerner EHR up and running started in 2008. Cleveland was part of the informatics team that helped launch the EHR in ambulatory clinics first, and later in acute care facilities.
Since then, he has become a champion of EHRs, working to help other physicians get the most out of the technology. Perhaps it’s payback of sorts for what, by his own account, the EHR has done for him – and his patients.
Cleveland paints a typical scenario he encounters.
He sees children who’ve been in the newborn intensive care nursery for two months – because they were born prematurely at 26-week gestation. They’ve been discharged on Monday, and he’s seeing them on Wednesday.
“I’ve got a two-month hospital stay that I can actually go back and look at,” Cleveland said. “All the problems are neatly categorized in a problem list. All the meds are in front of me. All the procedures are right there tabulated in one place, That’s a goldmine.”
These days, after having the EHR in place for a decade, the efforts at Carolinas HealthCare are all about optimization, better integration of tools in clinician workflow.
“One of the things I love about our EMR,” Cleveland said, “is that in the decade since we started using it, a lot of the vendors have come up with a mobile solution.”
Cleveland uses Cerner’s Power Chart Touch. It’s a mobile version of the electronic health record, which is available on Cleveland’s phone or on his iPad, and it helps him to be more productive and better engages his patients, he said.
Lots more here:
You can find the same spread of views here in Australia with some hospitals taking to advanced systems like ducks to water (RNSH maybe) and others being very unhappy and frustrated (parts of SA Health). What I am keen to understand is what are the factors that move things one way of another?
It is certain there are multitude of factors including – at the least.
1. The quality, intuitiveness and ease of use of the software.
2. The adequacy of the provisioning of the system so it performs quickly and smoothly.
3. The adequacy of the support and training for the system users.
4. The flexibility of the implementation to accommodate workflows etc.
5. The match of the software to the work-practices in the organisation.
6. The characteristics of the users (age, tech literacy etc.)
What would you add to this list and what do you see as the critical success factors?
Also how do these factors affect GP systems?
Comment more than welcome!
David.
The freedom to choose to exit from an EHR adoption should not be overlooked. What does not work today should not be seen as a blocker to future use as technologies evolve. Perhaps rather then being bound to an investment some are now better positioned to take advantage of next generational EHR systems at a time of their choosing.
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